As a member, navigating the health care world can be complicated, frustrating and overwhelming.  Navigation Health’s Care Navigation makes it easy by providing members their own personal health care concierge to help guide the way.  With just one phone number to call for all needs,  the Care Navigator will explain benefits, answer questions, research and schedule procedures with high quality, fair priced contracted providers in the area.  The Care Navigator is the members advocate for all pre-service and any post service support and guidance.

An unbelievable 25 cents of every healthcare dollar are consumed by administrative waste. Claims, billing, and collections activities do nothing to improve quality and clinical outcomes, but they do destroy the consumer experience and make price transparency virtually impossible. What would happen to healthcare costs if health plans replaced claims with immediate cash payment? Our NAVZERO Cash Pay Health Plan does just that by paying a fair and reasonable cash payment to providers by date of service. The result is lower healthcare costs (20% to 50%) and a dramatically improved healthcare payment experience for consumers, employers, and providers. All this without losing any essential data for plan administration, reporting and analytics.

DPC or VPC not only provides better patient care and outcomes, but also major cost savings to the employer. Our DPC or VPC programs offer unlimited visits at zero cost and work in concert with our Care Navigator’s so members don’t get lost in transition and will always understand their plan options.

Medical overbilling costs self-funded employers and health plans billions of dollars every year. It is critical to have the right medical claims review and repricing company in place to properly manage billing errors, fraud, and abuse. We work with WellRithms as they have demonstrated the technical, medical, and legal expertise to maximize savings. In fact, they will guarantee their savings and fully shield the plan and its members from financial and legal liability.

Not all providers of healthcare are the same. Some providers have consistently better results, and some charge substantially more for the same services.  Higher costs and higher quality of care are not synonymous.  Our custom high-performance provider networks focus on direct contracting high-quality providers with fair and reasonable charges.  We replace the “one size fits all” leased network model with a cost-effective custom network created around the specific needs of our clients and their employees.   Our high-performance direct contracting model provides unmatched flexibility to deliver the most efficient, cost-effective coverage attainable.

VBP aka Referenced Based Pricing (RBP) is a significant cost containment strategy – but because there is no contract, providers can balance bill the member which can be very disruptive to the plan.   VBP Direct does not leave balance billing to chance.  Through navigation to direct contracts or through claim negotiation (pre- and post-service) we have nearly eliminated balance billing issues while still securing the absolute best facility pricing.  However, when balance bills do occur dedicated Care Navigators take the lead in settling the dispute which includes legal services.  Certain balance bill indemnification programs may be available that cover both the plan and member of any financial responsibility should a settlement over plan limits be required.

It is no secret that pharmacy costs especially specialty drugs have skyrocketed over the last several years.  It is also no secret that there’s a lot of “fluff” built into PBM contracts.  That is why Navigation Health works with   the top transparent PBM in the industry that retains zero revenue from manufactures or pharmacies passing 100% of savings including rebates directly to clients.  To combat the high-cost specialty drugs, our PBM takes advantage of the total manufacture’s coupon/copay on hundreds of drugs passing the savings on to the client and also utilizes the Tele340B program.  We also engage sourcing of Patient Assistance Programs, international procurement, and healthcare tourism.  Through our various programs, we can save clients 30% to 80% on specialty drugs.

Studies show that more than one-third of medical diagnoses are misdiagnosed.  A recent Mayo Clinic study found that 88% of the patients who came to the clinic for a second opinion learned that their diagnosis had been changed or moderately altered.   Second opinions can play an important part in a self-funded health plan, both for patient peace of mind and savings to the plan.   Second opinions are provided free to the member on certain diagnosed procedures that meet the criteria for a higher potential of misdiagnosis and higher risk to the member.

Utilized by our Care Navigators to provide purchasers of healthcare a clear picture of how reliably hospitals and physicians are delivering the best outcomes and appropriate care across the continuum at the greatest value.

Navigation Health has preferred Stop-Loss Carriers / MGUs that have analyzed our health plan programs that have incorporated many of these cost containment strategies and are giving maximum credit to their rates and factors. In addition to traditional experience underwriting, we have MGU’s that utilize various forms of AI underwriting for groups as small as ten (10) enrolled employees without needing health questionnaires or claims experience. Great for groups wanting to move from fully insured or coming out of association or PEO plans etc. with no experience.

Data warehousing allows in-depth reports to be developed to identify trends in health care spend (a macro view) as well as opportunities for specific, member level care improvement/cost avoidance (a micro view).  Our reporting services provide guidance for evaluating health plan performance, benefit planning, and areas of costs avoidance and clinical intervention opportunities

Navigation Health only works with top tier benefit administrators that deliver innovative technology and administration solutions to control rising health care cost.  Services include – claims administration, COBRA, FSA & HRA.

We have access to Centers of Excellence and other quality surgical facilities and the best surgeons that offer all-inclusive, low-cost bundled, transparent prices for more than 400 inpatient and outpatient procedures.  These arrangements offer high quality providers, better outcomes, massively reduced costs, better member experience and often come with a re-admission warranty.  They are a win-win, both to the self-insured employer paying just one much lower transparent payment and to the member not having any out-of-pocket costs.